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Author: Dianne Mitchell Created: 5/16/2011 9:38 AM
Orthotic Therapy Blog

By Dianne Mitchell on 11/12/2014 9:21 AM

By Dianne Mitchell on 11/5/2014 9:20 AM

By Dianne Mitchell on 10/29/2014 9:17 AM

By Dianne Mitchell on 10/22/2014 9:16 AM

By Dianne Mitchell on 2/12/2014 9:29 AM
What can you do to your orthotic rx to help decrease pain to this area!!
By Dianne Mitchell on 2/5/2014 9:24 AM
Diabetic with a new pair (about 1-2 months old) of accommodative orthotics. He came in with a large sub 1st met head and hallux base callus wanting options. No accommodations are on the devices, these are simple inserts. On exam this is a neuropathic diabetic, h/o ulcers to the feet, presently intact skin and a noted hallux rigidus. The patient is worried about re-ulcerating.
By Dianne Mitchell on 1/30/2014 9:21 AM
Patient presented with a painful met head (2nd met). He is already wearing some custom molded orthotics and someone had added a met pad to the device. He removed it due to increased pain. What was the problem? What are your options?
By Dianne Mitchell on 11/6/2013 9:41 AM
A patient presented to the office today with a pair of functional foot orthotics in his hands asking for a second opinion. He reports pain on the rim of the heel to both feet since about a week of wearing them. He stopped wearing them while waiting to see me.
My immediate thought was that the devices were too narrow in the heel cup. He stood on them for me and, yes, they were indeed too narrow. What can you do with this pair of orthotics to adjust them to fit the patient?
Couple options: (Note: These options would certainly depend on whether or not the patient's heel even fits in the heel cup! I make sure the heel fits in the heel cup non-weightbearing first.)
- raise the patient up out of the heel cup with a small heel lift underneath the top cover (Korex or poron works well)
- shallow out the depth of the heel cup (this requires a grinding wheel) this will effectively widen the orthotic

I also educate the patients and make sure they under ...
By Dianne Mitchell on 11/4/2013 9:03 AM
We see many diabetic foot ulcers in the office. My goal is to not only heal the wounds, BUT also prevent recurrent wounds. An example is: A diabetic foot ulcer on the plantar hallux base. On exam of the mechanics of this particular foot there is a functional hallux limitus. Once this ulceration is healed, what can you do to decrease the pressure to this region? AND prevent recurrence?

Couple thoughts on this one:
- functional foot orthotic with a diabetic top cover and addition, or integration, of a reverse Morton extension to allow plantarflexion of the 1st metatarsal. This will offer decreased pressure to the otherwise jammed hallux and the limitus.

- next, you must decrease the recurrent friction. The best way to do this is to add a piece of PTFE (minimal coefficient of friction) to the area that the hallux and first metatarsal head contact.

Together, these modifications will help to decrease the recurrence rate of the ulcerat ...
By Dianne Mitchell on 10/24/2013 9:28 AM
Patient came in today with a painful metatarsalgia to the central metatarsals 2-3-4. She happened to be wearing her functional foot orthotics which appeared appropriate for her foot shape and type. What can you do in the office to help with pain?

Couple of options:

- add a top cover for padding
- add a forefoot extension of simple poron or soft EVA for paddling beneath the top cover for reinforced padding
- add a metatarsal bar just proximal to the metatarsal heads in order to attempt offloading the painful metatarsal heads

I usually trial these above options in the above order.

I also examine the patient for equinus deformity and start a stretching program.
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